Healthcare Provider Details

I. General information

NPI: 1942378187
Provider Name (Legal Business Name): VISION INTERNATIONAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 VALLEYGATE DR
FAYETTEVILLE NC
28304-3688
US

IV. Provider business mailing address

2047 VALLEYGATE DR
FAYETTEVILLE NC
28304-3688
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-3937
  • Fax: 910-221-3672
Mailing address:
  • Phone: 910-485-3937
  • Fax: 910-221-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG GARDNER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 910-221-3670